A Mindfulness Practice for Health and Well-being: Behavioural Awareness and Change

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I have lived my entire life with chronic illness. And as a psychotherapist, I have worked exclusively with people living with chronic and life-threatening medical conditions. Through all of these experiences, I have learned that we can increase the odds of improving our health and well-being through mindfulness-based behavioural practices.The practice I describe here is a way of living that serves to increase your awareness of your behaviour throughout the day so you can assess whether you are acting in the most effective ways to meet your needs and goals. For those of us living with chronic health challenges, our needs and goals often relate to health, although this mindfulness-based approach to behavioural change is useful to healthy people as well, as this way of life explores whether your behaviour is in harmony with how you want to live your life—with what matters most to you.
When you are able to observe times when your behaviour is not in harmony with your personal life values, or when it is not contributing to helping you meet your needs, you can then use that awareness to help you consciously choose to act in ways that are more likely to help you meet those needs, and that are in accord with what matters most to you in life.

What Are You Choosing?
The crux of this mindfulness-based behavioural change system to create greater wellness in your life is to recognize and take advantage of a simple fact: that every moment of the day presents an opportunity to choose how you will live. These frequent and often small choices will largely determine the quality of your life—usually far more so than external events can determine it.
The ways you respond to the plethora of behavioural choices you are presented with each day constitute a daily practice. In this sense, life is a practice. Discovering this reality for yourself and acting in accordance with it are immensely freeing. You learn that you have much more room to move than you ever knew, even within the limitations and constraints of chronic health challenges.
Taking advantage of your freedom to choose entails becoming fully responsible (response-able) for making an earnest and repeated effort to consider your limitless choices in every moment and making those that are aligned with your personal life values.
Mounting evidence from brain scan research clearly demonstrates that every time you make a fully conscious choice, you reinforce the neural circuit for that choice, which makes it easier to make that choice again. Therefore, when you begin to recognize and act upon the choices that align with your values and promote health and happiness, you have the opportunity to make use of your own physiological circuitry to create wellness, consciously enlisting an aspect of your brain’s functioning that usually operates outside of your awareness.

How to Live by Choice
Living by choice is not a mystery; the steps to doing so are simple. But it does not come easily, especially at first. If it did, everyone would drop their old habits and start living with intention so they could reap all the benefits and live healthier, happier lives. The challenge of living by choice is to make the commitment to practice the following steps and practice them consistently over time.
Set an intention to make conscious choices throughout the day, each day.
Since most of us live quite unconsciously most of the time, setting this intention is a step that needs to be revisited again and again.
Cultivate awareness of how often you make unconscious choices throughout the day.
For this step, notice those times when you are engaged in doing something you did not deliberately decide to do: eating a food that is not healthy for you, eating until you feel full, or obsessing over an upcoming medical appointment. You don’t need to change anything; simply notice that you’re doing something you did not set out to do. This can prove very illuminating, and you will get better at it with practice.
Notice how often your behaviour is not aligned with your values.
This is where the real power in living by choice lies: discovering the things you do that don’t line up with what you value most. This disconnect is the source of great emotional distress and physiological stress, and when you develop the ability to recognize the discord, you gain the opportunity to choose a different, much more health-affirming course.
Make conscious choices as often as you can.
Over time, you will learn to recognize the great variety of decision points you reach throughout the day. When you notice that there is a choice to make—whether to continue ruminating about an upcoming medical appointment, perhaps, or whether or not to call upon a friend for support—you will improve your skills in living according to your personal values.
Make conscious choices throughout the day that are in harmony with your personal life values.
With this step you can fulfill the promise of living by choice. For example, say you’ve been avoiding asking for a friend’s help for fear of being a burden. Then you recognize how much you value support, loving self-care, and authentic self-expression, so you pick up the phone and make the call. Taking valued action cultivates a strong sense of mastery, of knowing that you are the one in charge of your life. It is in such seemingly minor decisions that the promise of living by choice is found, because all the choices that line up with your values contribute to your health and wellbeing. And they add up!

A Few Examples of Living by Choice
To help you understand how living by choice works in practice, here are a few examples of how I do it myself.
- When I sit down at my desk, I choose to breathe diaphragmatic-ally and slowly. Normally, without consciously making that mindful, intentional choice, my respiration would automatically become shallow and rapid as I dove into my work each day. Healthy breathing improves brain function and physiological functioning in general.
- A caregiver is providing me with substandard care. Before confronting the person, I choose to breathe diaphragmatic-ally and slowly, and I choose to clarify my intention in my mind before speaking to that person.
- Upon waking up I realize I’m thinking that I have to go to an invasive medical appointment. Then I remind myself that I don’t actually have to go: I chose to make the appointment, and I am doing so because I value health and living with a sense of being in control of my life.
- My wife and I are checking out of a bed and breakfast inn. Two petite women (my wife and the desk clerk) carry our heavy bags out to the van where I am already seated. The desk clerk gives me a look that triggers feelings of shame. I recognize that I feel this way because I think I should be able to carry the bags myself. I take valued action and choose to practice self-compassion, reminding myself that I did not choose to develop Ankylosing Spondylitis, and that I am practising good self-care by not causing further damage to my spine.

Guidelines and Practices for Living by Choice
The essence of living by choice is to practice intention and mindfulness in order to develop an increased sense of control in daily life. This sense of mastery increases as you develop the skill of living with conscious intention and making conscious choices, moment by moment, throughout the day. The following practices can help:
1. Ask the fundamental question: What am I choosing in this moment? Two examples: I’m choosing avoidance. Or, I’m choosing to reach out to someone.
2. Ask: Am I making choices that are aligned with my personal life values?
3. Ask: What is my intention in this moment?
4. Ask: What action can I take in this moment to improve my well-being?
5. Every time you find yourself saying have to, need to, must, or should, say instead I choose to. The fact is, in each case, you have chosen, and if that choice is in alignment with what you value, it’s a choice that enhances wellness.

It can be a challenge to remember to practice these conscious choice exercises throughout the day; it takes time to develop the habit, and even when you can do it fairly routinely, it’s easy to lapse into unconscious behaviour. Though it may seem like an easy thing to do, in the beginning it is actually very difficult to remember to ask the fundamental question! Until it becomes a habit, you may find it helpful to set random alarms on your mobile device to prompt you to ask: What am I choosing?
Another way to remember is to use uncomfortable emotions as signals to ask the fundamental question. For example, if I am feeling anxious, take that as a cue, and ask the question, the answer may be that I am choosing to worry: something I usually do unconsciously since I know it causes emotional and physiological stress and thus I would not consciously choose to do it. Emotional discomfort is often a signal that you have made unconscious choices. As such, it’s an invaluable tool for supporting a shift to living by choice.

"I Am Choosing …" Practice
There is another layer of practice in addition to asking the fundamental question. Once you’re comfortable with the idea of asking the question and noticing your answers, you can mentally declare your choices to yourself as you go through your day:I am choosing to get out of bed.I am choosing to put on my exercise clothes.I am choosing to exercise.I’m choosing to complain about the pain in my back.I’m choosing to focus on the benefits of the invasive test I chose to get.

The purpose of this practice is to reinforce the realization that literally everything you do, you do by choice; it reinforces the power of choice. Although thoughts automatically pop into your head, you can choose what to do with them; you can get caught up in them or you can choose to recognize them as nothing but insubstantial mental constructs, which you do not have to obey.
An example of how mindfulness-based behavioural change practice works
Let’s say you’re sitting at the table eating and you say to yourself, I am choosing to eat. If you begin to feel full, the very simple act of making this statement serves to increase your awareness of this. In that instant of awareness, you now have the opportunity to say, I am choosing to stop eating immediately and I am choosing to put this food away. Just saying the words I am choosing to eat serves to put you in full contact with your experience of that moment.
This practice involves making the phrase I am choosing a part of moment-to-moment awareness, and this moment-to-moment emphasis on choice is a powerful antidote to the feelings of helplessness and hopelessness that so often plague those of us who live with chronic medical conditions and who feel lost in the health care system.
The most important reason to preface every behaviour with I am choosing
The power of this practice is that it allows you to take control of your life and step out of the poor me, helpless-hopeless, victim-type thinking that is all too common among those of us living with chronic health challenges. You are not helpless; you have a range of choices in virtually every moment of your day. Prefacing all behaviour with I am choosing serves to reinforce this truth and helps you take advantage of it so you can live your life with mastery.
Action is the catalyst for change. The actions you take throughout your day constitute a daily practice. Armed with your new and expanding awareness of the myriad decision points that are available to you moment by moment—your limitless freedom to choose—you are now prepared to take advantage of these skills and live your life engaged in behaviours that create wellness.
You create your own reality through the behaviours you choose—whether consciously or unconsciously. And one of the most destructive behaviours you can engage in, one that people with chronic illnesses can easily lapse into, is blaming someone or something else for your state—whether the state of your illness itself or your own internal experience of it. If you go through life blaming other people, corporations, governments, bad luck, or even the weather for whatever it is you don’t like about your life, you are doomed to experience more of it. This is because you have effectively disempowered yourself, placed someone or something else in charge, and lost control. You have framed yourself as a helpless victim, which is one of the worst things you can do for your health.
When you practice living mindfully and consciously choosing all your behaviors, you feel happier, stronger, and more alive. Living with conscious intention in this way leads to mastery: the felt sense that you are in charge of your life, a sense that can make all the difference in your daily experience.